mm disorders and tx pt one Flashcards
Musculoskeletal Disorders
which are centrally maintained
- Myofascial Pain Syndrome (MFPS)- Centrally Maintained
Pain - Myalgia
- Fibromyalgia- Centrally Maintained Pain
- Spasm
- Myositis
mc Musculoskeletal Disorder
myalgia
which Musculoskeletal Disorder is tx by rheumatologist
fibromyalgia
main tx modality for musculoskeltal dx
PT
spasms can follow?
trauma/bruxism
myostitis can follow
trauma/infection
Mechanisms that produce Pain for Masticatory skeletal muscles
Myofascial Pain Syndrome characterized by?
Characterized by the presence of Trigger Points (TPs) in any voluntary muscle which cause referred pain and referred tenderness and may be active or latent up palpation/function.
TPs evoke?
TPs evoke referred pain which usually originates from a distant site
rather than the site of the pain complaint.
ACTIVE TPs
ACTIVE TPs: are painful to palpation or spontaneously produce local pain OR refer pain and autonomic symptoms (i.e. erythema) to remote areas in reproducible patterns characteristic of each muscle
LATENT TPs
could occur with?
LATENT TPs: exhibit local tenderness but do not currently cause
spontaneous clinical pain or symptoms.
could occur with previous trauma that was not adressed
Myofascial Trigger Point
DEFINITION:
pain sensation described?
An irritable locus within a taut band of skeletal muscle or fascia which when stimulated elicits referred pain & tenderness (“secondary hyperalgesia- increased sensitivity to normally painful stimuli outside & surrounding a zone of primary hyperalgesia”). (1)
Referred pain from myofascial trigger points is dull and aching, usually deep, and can range from discomfort to incapacitating pain.
1/2 nn interconnect which can allow pain to cross CN distributions (5/11
Muscle Palpation Examination
Remember that the pain location ?
Palpate which muscles with mouth open
Muscle Palpation Examination
Remember that the pain location MAY not be the source of pain
Palpate the Masseter and Temporalis muscles with mouth open
Myofascial Pain Syndrome (MFPS)
May be found in what mm?
mediation?
May be found in any voluntary muscle
Is a Centrally Mediated Pain. Fields (4) described a means where the CNS may switch on Nociception by stimulating the “on” cells which causes activation of the Trigeminal Nucleus nociceptors
Myofascial Pain Syndrome, chronic?
Is chronic, continuous muscle pain (myalgia) that is aggravated by function and refers pain beyond the boundary of the masticatory muscle being palpated
Nociception:
Nociception: “stimulation of specialized nerve endings designed to transmit
information to the central nervous system concerning potential or actual tissue
damage
Nociceptor:
Nociceptor: “a specialized nerve ending that senses painful or harmful sensations”
(i.e. a primary afferent nerve)
Myofascial Pain diagnosis difficulty, why?
scm refferal patterns
Myofascial Pain
The most elusive and difficult to diagnose since it refers
pain to other locations in the mouth and in the face and
head & does Not always follow Cranial Nerve Distributions-
(CN XI with active SCM trigger point refers to CN V in face
and head)
Myofascial Pain
Diagnostic Criteria: (must be present):
pain type? aggrevated by?
tps?
> 50% pain reduction occurs with?
Regional dull, aching pain aggravated by mandibular function when muscles of mastication are involved.
Trigger points have a characteristic pattern of pain referral & alters the pain complaint on palpation or spontaneously.
> 50% pain reduction occurs with vapocoolant spray or local anesthetic injection (trigger point injection) using 1% Procaine without vasoconstrictor.
Myofascial Pain
May be accompanied by:
Muscle?
Sensation of?
Ear? teeth? HA?
ROM?
pain in referal region
Muscle stiffness
Sensation of acute malocclusion not verified clinically.
Ear Symptoms, tinnitus, vertigo, toothache, tension-type headache.
Decreased mouth opening (if masticatory muscles involved).
Hyperalgesia in region of referred pain.